Alginate 

[11][2][12]

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Function

• Moisture absorption 
  
• Facilitate autolytic debridement
  
• May assist in control of minor bleeding
• May help decrease bacterial load through bacterial sequestration in gel
• Fill in dead space

Composition

• Derived from brown seaweed (biodegradable)

Properties

• Absorb 20 times its weight
• Interact with exudate to form a soft gel and maintain a moist environment
• Conform to the shape of a wound
• Easy to apply and remove (one piece removal)

Configurations

• Sheet, rope and combinations including silver, gelling fibers, charcoal, honey, hydrocolloid, and hydrogel

Secondary dressing

• Required

Autolytic

++ 

Infection

+ 

Balance

+++

• Partial and full-thickness 

Exudate:

• Moderate to very heavy

Infection:

• Infected and non-infected

Wound bed:

• Red (granulating) and yellow (fibrin/slough) 

Tunneling 

Do not use if:

• Known sensitivity to alginates
• Heavy bleeding
• Hydrogel is being used 

Precaution:

• Dressing performance may be affected by excessive use of petroleum-based ointments
• Direct application on dry or lightly exuding wounds may result in excessive adherence to wound. In this case, moisten with saline to help removal. 
  
  

Gelling Fibers 

[2][11][12][13][14]

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Function

• Moisture absorption
• Facilitate autolytic debridement
  
• May help decrease bacterial load through bacterial sequestration in gel
• Does not have hemostatic properties
• Fill in dead space

Composition

• Composed primarily of carboxymethylcellulose (CMC), not degradable
  

Properties

• Absorb up to 30 times their weight (more than alginate)
• May provide less risk of maceration compared to alginate due to vertical fluid absorption properties (alginate absorbs laterally)
• Interact with exudate to form a soft gel and maintain a moist environment
• Conform to the shape of a wound
• Easy to apply and remove (one piece removal)

Configurations

• Sheet, rope and combinations including silver, alginate, and charcoal

Secondary dressing

• Required

Autolytic

++

Infection

+

Balance

+++

Thickness: 

• Partial and full-thickness

Exudate:

• Moderate to very heavy 

Infection:

• Infected and non-infected

Wound bed:

• Red (granulating) and yellow (fibrin/slough)

Tunneling 

Do not use if:

• Known sensitivity to components
• Active bleeding
  
• Hydrogel is being used 

Precaution:

• Dressing performance may be affected by excessive use of petroleum-based ointments
• Direct application on dry or lightly exuding wounds may result in excessive adherence to wound. In this case, moisten with saline to help removal. 

Antimicrobials

[1][2][12]

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Function'

• Reduce bacterial levels
• May facilitate autolytic debridement (e.g, honey)
• May help with moisture absorption or donation, depending on underlying dressing material

Composition

• Antimicrobial agent such as silver, iodides, PHMB, honey or aniline dye, with a vehicle (dressing) for delivery
• Underlying dressing may be gauze, alginate, foams, or other types

Properties

• Broad spectrum against bacteria (do not cause bacterial resistance)
• Silver is activated from the dressing to the wound’s surface based on the amount of exudate and bacteria in the wound

Configurations

• Sheets, gels, alginates, foams, or paste

Secondary dressing

• May or may not be required, depending on dressing
  
  

Autolytic

Depends on product

Infection

+++

Balance

Depends on product

Infected wounds:

• NERDS: Nonhealing, increased Exudate, Red and friable tissue, Debris, Smell. Any 3 = local infection
• STONEES: increased Size, increased Temperature, Os, New breakdown, increased Exudate, increased Erythema/edema (cellulitis), Smell. Any 3 = deep infection

Exudate: 

• Minimal to high levels, depends on dressing

Do not use if:

• Known sensitivity to any product component

Precaution:

• May cause stinging or sensitization
  - Silver: may cause staining on wound and intact skin, reduces enzymatic activity of collagenase
  
  

Collagen

[2][12][15]

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Function

• Encourage the deposition and organization of newly formed collagen, create an environment that fosters healing
• Provide moisture or absorption, depending on the delivery system (underlying dressing type)

Composition

• Usually formulated with bovine, avian, or porcine collagen (fibrous, insoluble proteins produced by fibroblasts), degradable

Properties

• Due to its chemotactic properties on wound fibroblasts, collagen stimulates cellular migration and contributes to new tissue development
• Conform to the shape of a wound
• Easy to apply and remove
• Nonadherent

Configurations

• Sheets, pastes,pads, particles, solutions, and gels

Secondary dressing

• May or may not be required, depending on dressing
  
  

Autolytic

-

Infection

 -

Balance

 -

Thickness:

• Partial and full-thickness

Exudate:

• Light to moderate 

Infection

• Non-infected wounds

Wound bed:

• red (granulating)

Tunneling wounds

Skin graft donor sites

Do not use if:

• Known sensitivity to any of the product components
• Wound is infected, has sinus tracts or excessive exudate
• Third degree burns
• Dry, necrotic wounds
• Active vasculitits

Precaution:

• Possibility of patient’s cultural issues related to source
  
  
  

Composite 

[2][4][12]

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Function

• Moisture absorption 
• Facilitate autolytic debridement
• Bacterial barrier
  

Composition

As per Medicare, a composite dressing must have: 

• A physical (not chemical) bacterial barrier that is present over the entire dressing pad and extends out into the adhesive border (if no adhesive border, not a composite dressing), and
• An absorptive layer other than an alginate or other fiber gelling dressing, foam, hydrocolloid, or hydrogel,
  and
• Either a semi-adherent or a non-adherent property over the wound site

Multi-component dressings that are not classified as composite dressings are categorized by Medicare according to the clinically predominant component.

Properties

• Conform to the shape of a wound
• Easy to apply and remove
• Bacterial barrier, moisture absorption, autolytic activity and nonadherence to wound in a single product
  

Configurations

• Sheets with or without adhesive border

Secondary dressing

• Not required
• May be used as primary or secondary
  

Autolytic

 +

Infection

-

Balance

+++

Thickness:

• Partial and full-thickness 

Exudate:

• Minimal to moderate 

Infection:

• Infected or non-infected wounds

Wound bed: 

• Red (granulating), yellow (fibrin/slough), black (moist eschar)
  
  

Precaution:

• Use with caution if infection is suspected
• Require a border of intact skin for anchoring the dressing
  
  

Contact Layer

[2][12][4]

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Function

• Protect wound base from trauma during dressing changes, by lining the entire wound to prevent adhesion of the overlying dressing to the wound
• Not intended to be changed with each dressing change. They remain on the wound for an extended time while the absorptive dressings are changed
• No autolytic activity
• Not absorptive

Composition

• Composed of a single layer of a woven (polyamide) net that acts as a low-adherence material

Properties

• Designed to allow wound exudate passes to a secondary dressing
• May be applied with topical medications, wound fillers, or absorptive dressings
• Can be used with NPWT for the protection of fragile wound structures
• Conform to the shape of a wound
• Easy to apply and remove

Configurations:

• Sheet; may have oil, hydrocolloid, silicon

Secondary dressing:

• Required
  
  

Autolytic

-

Infection

-

Balance

-

Thickness:

• Partial and full-thickness

Exudate:

• Minimal to heavy

Infection:

• Infected or non-infected wounds

Conditions include:

• Painful wounds
• Skin tears
• Skin grafts and skin substitutes (e.g. Apligraft, Dermagraf)
• Skin grafts donor sites
• Surgical incisions
• Radiated skin
• 1st and 2nd degree burns
  

Do not use if:

• Known sensitivity to product components (e.g, silicone, if present)
  
• Stage 1 pressure injuries
  
• Third degree burn
  
• Dry or necrotic ulcers
  
• Viscous exudate

Foam

[2][12][14][4]

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Function

• Moisture absorption
• Bacterial barrier (if occlusive backing)
• Fill in dead space (if filler)

Composition

• Non-adherent or adherent polyurethane
• May be manufactured with other materials such as oil, hydrocolloid, silicon, antimicrobial agents (e.g, silver)
• May have occlusive backing (bacterial barrier)

Properties

• Non-linting and absorbent, may have various levels of thickness
• May have non-adherent layer that allows non-traumatic removal
• May have other properties such as low tack, antimicrobial action or pain control, depending on product
• Easy to apply and remove

Configurations

• Sheet, pads, pillow (cavity) dressings
• With or without adhesive border

Secondary dressing

• May be required, depending on dressing
• May be used as primary for absorption and insulation, or as secondary for wounds with packing
  
  

Autolytic

-

Infection

-

Balance

+++

Thickness:

• Partial and full-thickness 
  

Exudate:

• Light to heavy, depending on product

Infection:

• Infected or non-infected wounds, depending on product

Wound bed:

• As primary: red (granulating), yellow (fibrin/slough) if used with enzymatic debrider 
  
  
  
  

Do not use if:

• Occlusive dressing should not be used on heavily exudative or infected wounds
• As primary on dry, necrotic black ulcers

Precaution:

• May macerate periwound skin if become saturated
  
  

Gauze

[4][16]

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Function

• Moist saline gauze: fill in dead space, mechanical debridement
• Impregnated with other substances: fill in dead space, may keep wound moist. May be antimicrobial if impregnated with antimicrobial agents
  

Composition

• Comprised of woven or nonwoven rayon, polyester, cotton or viscose
• Typically manufactured as a single piece of material folded into a several ply gauze pad
• May be non-impregnated or impregnated with substances such as iodinated agents, petrolatum, zinc paste, crystalline sodium chloride, chlorhexadine gluconate (CHG), bismuth tribromophenate (BTP), water, aqueous saline, hydrogel, or other agents  

Properties

• Non-woven dressings result in stronger pads with improved fluid wicking properties, compared to woven dressings
• Highly permeable, relatively non-occlusive: may desiccate wound beds with minimal exudate
• No autolytic activity. When used as wet-to-dry dressings, result in non-selective debridement, which may disrupt newly formed tissue and cause pain upon dressing removal.
• Not absorptive

Configurations

• Sheet, rope, rolls, squares
• With or without adhesive border

Secondary dressing

• Required if no adhesive border or if manufacturer recommends it 
• Non impregnated gauze can be primary or secondary dressing
• Impregnated gauze most often primary dressing

Autolytic

+++

(wet to dry)

Infection

-

Balance

+/-

Thickness:

• Partial and full-thickness 
  Exudate
• Minimal to heavy exudate, depending on product

Infection:

• Infected or non-infected wounds, depending on product 

Wound bed:

• Non-adherent gauze as primary: dry, non-healable black (eschar), red (granulating)

Precaution:

• May desiccate wounds with minimal exudate
• When cut, woven gauze can leave fibers in the wound, which may act as a foreign body and perpetuate inflammation
• While these dressings are inexpensive, they require frequent changing and ultimately incur higher cost due to care time and the volume of product used 

Hydrocolloid

[2][12][14][4][16]

[17]

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Function

• Moisture maintenance
• Facilitate autolytic debridement
• Reduce wound pain
• Bacterial barrier

Composition

• Occlusive or semi-occlusive dressing with a film outer layer and sodium carboxymethylcellulose, gelatin, pectin, elastomers, and adhesives
• Forms a yellow, malodorous gel on the wound surface, promoting moist wound healing (may be mistaken by infection). Some may leave residues or adhere to the periwound skin

Properties

• If transparent, allow observation of the healing process
• Conform to the shape of a wound

Configurations

• Sheet, paste wafers, powders
• With or without adhesive border

Secondary dressing

• Required if no adhesive border or if manufacturer recommends it
• May be used as primary or secondary dressings
• May be used as secondary dressing over an alginate when the drainage is moderate, or over a hydrogel to further facilitate autolysis.
  
  

Autolytic

+++

Infection

+/-

Balance

++

Thickness:

• Partial and full-thickness 
  

Exudate:

• Light to moderate exudate

Infection:

• Non-infected wounds

Wound bed:

• Black eschar with adequate blood supply, yellow (fibrin/slough), red (granulating) 

Conditions include:

• Initial debridement of venous ulcers, especially if wound is dry, with fibrinous slough

Do not use if: 

• Heavy exudate, sinus tracts, infections
• Fragile periwound skin: may cause maceration
• Exposed tendon or bone
• 3rd degree burns
  
• Vasculitis
  
• Hypergranulation
• Sensitivity to product components
• Stable, intact black eschar on heel
• Dry black eschar with unknown or inadequate blood supply

Precaution:

• Do not use if dressing needs to be changed more than every 3 days
• Use with caution on wounds that require frequent inspection (e.g, diabetic foot ulcers due to increased risk of infection)
  
  

Hydrogel

[2][12][14][4][16]

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Function

• Moisture addition
• Facilitate autolytic debridement
• Fills dead space (amorphous, impregnated gauzes)
• May reduce wound pain

Composition

• Viscous polymers with high water content (~80%)
• May contain other materials depending on the manufacturer

Properties

• Easy to apply and remove
• Conform to the shape of a wound
• Non-adherent so they do not harm the wound bed or surrounding skin

Configurations

• Amorphous gels, impregnated gauzes or sheet dressings.
• Sheets with or without adhesive border

Secondary dressing

• Amorphous and impregnated dressings require secondary dressing
• Sheets may be primary or secondary dressings
  
  

Autolytic

++

Infection

+/-

Balance

++

Thickness:

• Partial and full-thickness 
  

Exudate:

• None to minimal exudate

Infection:

• Non-infected and infected wounds

Wound bed:

• Black eschar with adequate blood supply, yellow (fibrin/slough) 
  
  

Do not use if: 

• Heavy exudate
  
• 3rd degree burns
  
• Sensitivity to product components
  
• Stable, intact black eschar on heel
  
• Dry black eschar with unknown or inadequate blood supply
   
  

Precaution:

• May be difficult to secure
  
• Some may cause periwound skin maceration
  
  
  
  

Specialty Absorptive

[2][12][14][4][16]

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Function

• Moisture absorption

Composition
As per Medicare, specialty absorptive dressings are unitized multi-layer dressings that provide:

• (a) either a semi-adherent or non-adherent layer, and 
  
• (b) highly absorptive layers of fibers such as absorbent cellulose, cotton, or rayon

These dressings may or may not have an adhesive border.

Properties

• Highly absorptive
• Easy to apply and remove
• Non-adherent so they do not harm the wound bed or surrounding skin

Configurations

• Sheet
• With or without border

Secondary dressing

• Required if no adhesive border or if manufacturer recommends it
• May be primary or secondary dressings
  
  

Autolytic

-

Infection

-

Balance

+++

Thickness:

• Partial and full-thickness 
  

Exudate:

• Moderate to heavy exudate

Infection:

• Non-infected and infected wounds

Wound bed:

• Red (granulating), yellow (fibrin/slough), black (necrotic)

Precaution:

• As a primary dressing, may not be appropriate for wounds with undermining
  
  

Transparent Film

[2][12][14][4][16]

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Function

• Moisture maintenance
• Facilitate autolytic debridement
• Bacterial barrier
  

Composition

• Semipermeable adhesive polyurethane sheet 
• Impermeable to water molecules and bacteria, but allow vapor to cross the barrier, thus maintaining moist healing environment to promote granulation

Properties

• Flexible and good for wounds on difficult anatomical sites (e.g, joints, toes) 
• Allow for wound observation
• Not absorptive
• Generally inexpensive
• May bathe or showe
  

Configurations

• Film 
  

Secondary dressing

• Not required
• May be used as primary or secondary dressing
  
  

Autolytic

+

Infection

-

Balance

-

Thickness:

• Partial thickness 
  

Exudate:

• None to minimal exudate
  

Infection:

• Non-infected wounds

Wound bed:

As secondary dressing for:

• Red (granulating), yellow (fibrin/slough), black (necrotic)
  

Conditions include:

• Primary dressing for partial thickness wounds with minimal or no exudate
• Prevent or manage stage 1 pressure injury
  
  

Do not use (as primary dressing) if:

• Infected wounds
• Wounds with moderate to heavy drainage, as it is not absorptive and may cause maceration
• Fragile periwound skin
• Full thickness wounds
• 3rd-degree burn

Precaution

• Should not be used on wounds that require frequent dressing changes, as it can last for several days without needing replacement
• May be difficult to apply and handle
  - May dislodge in high-friction areas
  
  

Wound Fillers

[2][12][14][4][16]

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Function

• Fill in dead space
• Moisture absorption or maintenance, depending on underlying material
• May facilitate autolytic debridement, depending on underlying material

Composition

• Depends on underlying material. Can be made of collagen, alginate or other fiber gelling, foam, hydrocolloid, hydrogel, non-impregnated packing strips and other dressing materials.

Properties

• Easy to apply and remove
• Depends on underlying material

Configurations

• Hydrated forms (e.g., pastes, gels), dry forms (e.g., powder, granules, beads), or other forms such as rope, spiral, pillows, etc. 

Secondary dressing

• Required
• Used as primary dressing
   
  

Autolytic

Depends on product

Infection

Depends on product

Balance

Depends on product

Thickness:

• Partial and full thickness 
  

Exudate:

• Light to moderate exudate

Infection:

• Non-infected and infected wounds, depending on dressing

Conditions include:

• Wounds that need packing to fill dead space (cavity, undermining, etc)
  
  

• Depends on specific product and underlying material
• Generally contraindicated for use on wounds with no or minimal exudate
• 3rd-degree burns 
  
  

Alginates
[11][2][12]

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• Cleanse with saline or other wound cleanser, dry peri-wound skin
• Cut dressing to cover wound, ensure overlap by 1 cm onto the periwound skin. May fold dressing if heavy exudate
• Heavy exudates: apply directly to wound base & change daily initially
• For cavities, sinus tract or undermining: lightly pack one piece (where possible) of ribbon, leave visible tail for easy removal
• Apply secondary dressing such as gauze, to maintain a moisture balanced wound environment

• Alginate gels in contact with exudate and absorbs its color. Using forceps, remove dressing in one piece. If forceps unavailable, may remove with gloved forefinger and thumb using a 2x2 gauze. Gently irrigate with saline to flush residual dressing from wound bed
  
• If dressing is dry and hard to remove, saturate it with sterile saline or sterile water and allow liquid to soak into the dressing until dressing is soft

Gelling Fibers

[2][11][12][13][14]

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• Cleanse with saline or other wound cleanser, dry periwound skin
• Cut dressing to cover wound, ensure overlap by 2 cm onto the periwound skin
• Heavy exudates: apply directly to wound base & change daily initially
• For cavities, sinus tract or undermining: lightly pack one piece (where possible) of ribbon, leave visible tail for easy removal
• Apply secondary dressing such as gauze, to maintain a moisture balanced wound environment
  
  

• Gelling fibers gel in contact with exudate and absorbs its color. Using forceps, remove dressing in one piece. If forceps unavailable, may remove with gloved forefinger and thumb using a 2x2 gauze. Gently irrigate with saline to flush residual dressing from wound bed
• If dressing is dry and hard to remove, saturate it with sterile saline or sterile water and allow liquid to soak into the dressing until dressing is soft
  
  

Antimicrobials

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Collagen

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Composite

[2][12][4][18]

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• Cleanse with saline or other wound cleanser, dry periwound skin
• Choose a size so that dressing overlaps intact periwound skin by 2 cm. Do not cut to fit
• Remove the first tab from the underside of the dressing.
• Adhere the exposed adhesive side on one side of the wound.
• Remove the second tab and adhere the rest of the dressing over the wound.
  
  

• Gently lift one corner of the dressing.
• Roll it away from the wound while holding the skin away.
• Gently lift the other corners and pull upwards until the dressing completely peels off.
  
  

Contact Layer

[2][12][4][18] 

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• Cleanse with saline or other wound cleanser, dry periwound skin
• Moisten gloves with sterile solution to prevent silicone from adhering to gloves
• Cut dressing to cover wound, ensure overlap by at least 2 cm onto the periwound skin
• Apply directly to wound base as a single layer, with no folding, tacky side to the wound
• Remove remaining protective film, smooth it in place to obtain a good seal
• If more than one piece is needed, overlap margins of dressings but make sure holes are not blocked
• Apply secondary dressing, to maintain a moisture balanced wound environment
  
  

Should not be changed in every dressing change. Secondary dressing may be changed and contact layer left up to 7 days

• Remove secondary dressing
• Lift one corner of the contact layer and peel back from the wound
  
  

Foam

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Gauze

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Hydrocolloid

[12][18][19]

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• Cleanse with saline or other wound cleanser, dry periwound skin 
  
• Choose a size so that dressing overlaps intact periwound skin by 3 cm
• Warm the dressing between your hands
• Remove part of the white release paper, being careful to minimize finger contact with the adhesive surface.
• Hold the adhesive side of the dressing over the wound. Align the dressing with the center of the wound. Gently apply the center part of the dressing in a rolling motion. Smooth into place
• Remove the "bottom" white release paper while rolling the dressing in place - but don't stretch it.
• Use tape to secure edges if needed
• Gently mold the dressing into place for 30-60 seconds.

TIPS: 

• May curl at edges and can be difficult to apply to ulcer base, may apply to primary dressing (e.g gauze, foam, alginate, gelling fibers), then apply both to ulcer.
• Recommended re-assessment in 48-72h of first application. 
  
  

• Gently lift one corner of the dressing.
• Roll it away from the wound while holding the skin away.
• Gently lift the other corners and pull upwards until the dressing completely peels off.
  
  

Hydrogel

[12][18][19]

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Amorphous gel, impregnated gauze:

• Cleanse or irrigate,
• Apply skin prep to periwound, allow to dry,
• Fill wound with gel bed 5mm thick or impregnated gauze with gel.
• Cover with secondary dressing (gauze, foam or transparent film dressing).

Sheet:

• Cut to wound size and apply sticky side to wound. 
• Cover with secondary dressing.

TIPS:

• if hydrogel impregnated gauze is unavailable, may use plain non-woven gauze impregnated with hydrogel gel
  
  

Amorphous gel:

Flush with saline or water
Impregnated gauze: 

• Gently remove dressing, then flush with saline or water
  

Sheet: 

• Gently remove dressing away from wound
  
  

Specialty Absorptive

[12][18][19]

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Transparent Film

[12][18][19]

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• Cleanse with saline or other wound cleanser, dry periwound skin 
  
• Choose a size so that dressing overlaps intact periwound skin by 2 cm. May cut to fit
• Remove the first tab from the underside of the dressing.
• Position dressing over the wound, press it down gently around the perimeter of the wound
• Remove the second tab and adhere the rest of the dressing over the wound. Peel back tab of the outer surface if present
• Smooth dressing out firmly from the center toward the edges

• Gently lift off one edge of dressing and pull it away from wound, in the direction of hair growth
• Remove immediately if there’s skin irritation, leakage or loosening of the film, or if it begins to roll up at the corners. 
  
  

Wound Filler

[12][18][19]

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 Alginates

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Covered for:

• Full thickness
• Moderate to heavy exudate

Not covered for:

• Dry wounds
• Wounds covered with eschar

Note:

• When alginate is used as a primary dressing, a secondary dressing is also covered 
  
  

Gelling Fibers

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Same as for Alginate

A6196—pad size <16 in2
A6197—pad size >16 in2 but <48 in2
A6198—pad size >48 in2 
A6199—wound filler, per 6" (15 cm)

Covered for:

• Full thickness
• Moderate to heavy exudate

Not covered for:

• Dry wounds
• Wounds covered with eschar 

Note:

• When gelling fiber is used as a primary dressing, a secondary dressing is also covered 

Antimicrobials

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Collagen

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Covered for:

• Full thickness wounds (e.g., stage 3 or 4 ulcers)
• Wounds with light to moderate exudate, or
• Wounds that have stalled or have not progressed toward a healing goal. 

Not covered for:

• Wounds with heavy exudate, third-degree burns, or when an active vasculitis is present
  
  

Composite

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Covered for:

• Moderately to highly exudative wounds. 

Notes:

• If dressing with adhesive border or if dressing with impervious backing layer is used, Medicare will typically not cover tape or a secondary dressing on top of it
  
  

Contact Layer

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Covered for:

• To line the entire wound to prevent adhesion of the overlying dressing to the wound

Not covered: 

• When used with any dressing that has a non-adherent or semi-adherent layer as part of the dressing.
  
  

Foam

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Without an adhesive border: 

• A6209—pad size = 16 in2 
• A6210—pad size > 16 in2 but = 48 in2 
  
• A6211—pad size > 48 in2
  
• With an adhesive border: 
  
• A6212—pad size =16 in2 
  
• A6213—pad size > 16 in2 but = 48 in2 
  
• A6214—pad size > 48 in2 
  
• Wound fillers: 
  
• A6215—per gram
  
  

Covered for:

• Full thickness wounds (e.g., stage 3 or 4 ulcers) with moderate to heavy exudate. 

Note:

• If dressing with adhesive border or if dressing with impervious backing layer is used, Medicare will typically not cover tape or a secondary dressing on to of it

Not covered:

• When used with any dressing that has a non-adherent or semi-adherent layer as part of the dressing.

Gauze

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Covered:

• Gauze, impregnated with other than water, normal saline, hydrogel or zinc paste

Not covered:

• Gauze, Impregnated, Water Or Normal Saline (A6228-A6230)

Note:

• Medicare covers a secondary dressing when primary dressing is a impregnated gauze dressing.
• If dressing with adhesive border or if dressing with impervious backing layer is used, Medicare will typically not cover tape or a secondary dressing on top of it
• Gauze or other dressings used to cleanse or debride a wound but not left on the wound
• Non-impregnated gauze dressing: It is usually not reasonable and necessary to stack more than 2 gauze pads on top of each other in any one area
  
  

• Non-impregnated gauze, without border: up to 3 times per day
• Non-impregnated gauze, with border: once per day
• Gauze impregnated with other than water, normal saline, hydrogel or zinc paste: up to once per day
  
  

Hydrocolloid

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Without an adhesive border: 

• A6234—pad size <16 in2 
  
• A6235—pad size >16 in2 but <48 in2 
  
• A6236—pad size >48 in2

With an adhesive border:

• A6237—pad size <16 in2
• A6238—pad size >16 in2 but <48 in2 
  
• A6239—pad size >48 in2
  

Wound fillers: 

• A6240—paste, per fluid ounce 
  
• A6241—dry form, per gram
  
  

Covered:

• Light to moderate exudate

Note:

• If dressing with adhesive border or if dressing with impervious backing layer is used, Medicare will typically not cover tape or a secondary dressing on top of it 
   
  
  
  

Frequency of replacement

• Up to 3 times a week

Hydrogel

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Without an adhesive border: 

• A6242—pad size < 16 in2 
  
• A6243—pad size > 16 in2 but = 48 in2
  
• A6244—pad size > 48 in

With an adhesive border:

• A6245—pad size < 16 in2
• A6246—pad size > 16 in2 but = 48 in2 
• A6247—pad size > 48 in2

Wound fillers:

• A6248—gel, per fluid ounce 
  

Gauze dressings impregnated with hydrogel without an adhesive border:

• A6231—pad size < 16 in2
• A6232—pad size > 16 in2 but = 48 in2
• A6233—pad size > 48 in2
  
  

Covered for:

• Full thickness wounds (e.g., stage 3 or 4 ulcers) with minimal or no exudate.
• Secondary dressing for a hydrogel impregnated gauze is covered

Not covered for: 

• Stage I, II pressure injury/ulcers.

Note:

• Not covered when more than one type of hydrogel dressing (filler, cover, or impregnated gauze) is used on the same wound
• Not covered when another absorptive dressing is used on the same wound at the same time (e.g., hydrogel and alginate).
• If dressing with adhesive border or if dressing with impervious backing layer is used, Medicare will typically not cover tape or a secondary dressing on top of it 
  
  

• Without adhesive border or hydrogel wound fillers: up to once per day.
• With adhesive border: up to 3 times per week.

Note: 

• The quantity of hydrogel filler used for each wound must not exceed the amount needed to line the surface of the wound. Additional amounts used to fill a cavity are not reasonable and necessary. Maximum utilization of code A6248 is 3 units (fluid ounces) per wound in 30 days.
  
  

Specialty Absorptive

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Without an adhesive border: 

• A6251—pad size <16 in2 
  
• A6252—pad size >16 in2 but <48 in2 
  
• A6253—pad size >48 in2 

With an adhesive border:

• A6254—pad size <16 in2 
  
• A6255—pad size >16 in2 but =48 in2 
  
• A6256—pad size >48 in2
  
  

Covered for:

• Moderately or highly exudative full thickness wounds (e.g., stage 3 or 4 ulcers).

Notes:

• It is not appropriate to use combinations of a hydrating dressing on the same wound at the same time as an absorptive dressing (e.g., hydrogel and alginate)
  
  

Transparent Film

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Covered for: 

• Open partial thickness wounds with minimal exudate or closed wounds
  
  

Wound Filler

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• For certain materials, Medicare established unique codes - i.e., collagen wound filler (A6010, A6011, A6024), alginate or other fiber gelling wound filler (A6199), foam wound filler (A6215), hydrocolloid wound filler (A6240, A6241), hydrogel wound filler (A6248), and non-impregnated packing strips (A6407)
  
• Wound fillers made of recognized dressing materials, not falling into any of these categories are coded as A6261 or A6262.
• Wound fillers comprised of substances that are not recognized as effective dressing materials are coded as A9270
  
  

Covered for:

• Coverage is based upon the characteristics of the underlying material(s) (e.g, see coverage for collagen, alginate, etc)
  
  

• Frequency is based upon the characteristics of the underlying material(s) (e.g, see coverage for collagen, alginate, etc)
  
• For A6261 or A6262: once a day